Provider Demographics
NPI:1427389212
Name:WESTERN DENTAL
Entity Type:Organization
Organization Name:WESTERN DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:HOSSAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEZHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-820-0333
Mailing Address - Street 1:5365 SPRING VALLEY
Mailing Address - Street 2:STE # 130
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5365 SPRING VALLEY RD
Practice Address - Street 2:STE #130
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-3097
Practice Address - Country:US
Practice Address - Phone:972-820-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty